| NPI | 1962483776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDD B WITTENBERG Owner 719-593-0403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 6775) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 5111) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2020-08-22 |